Pilomatrixoma of the Left Scapular Region in a Young Male: A Rare Case Report

Pilomatrixoma is a benign and rare neoplasm derived from the cortex of the hair follicle. The head and neck region's involvement is relatively common and occurs in the upper extremity, trunk, and lower extremity in decreasing tendency. It is usually encountered in younger age groups, usually in children and adolescents. Management of the pilomatrixoma involves surgical excision of the mass. A 15-year-old male presented with a history of an isolated left scapular mass. The lesion had appeared two weeks before the presentation. His parents brought him to the emergency department due to continued bleeding from the mass. He denied any pain, fever, night sweats, weight loss, chills, appetite changes, and numbness to the area. Physical examination revealed a bleeding non-tender mass measuring about 2.5 x 3 cm, with the fluctuant inferior surface. Baseline investigations were normal. Cyst, abscess, and neoplasm were the initial differentials. Ultrasound findings were suggestive of neoplasm, and contrast-enhanced MRI was highly suspicious for progressive neoplasm. The surgical team was consulted, and surgical excision of the mass was carried out. Biopsy results confirmed pilomatrixoma. In conclusion, the pre-surgical diagnosis of pilomatrixoma is difficult. Hence, this case report's main objective is to raise awareness among clinicians about this rare diagnosis and its clinical features. Furthermore, our case highlights the need to consider pilomatrixoma in the differentials of the head, neck, and back masses in children and adolescents.